Provider First Line Business Practice Location Address:
254 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-2678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-330-5456
Provider Business Practice Location Address Fax Number:
509-561-6229
Provider Enumeration Date:
04/14/2016